“Science” takes another u-turn…

CDC covid testing guidance goes from haphazard to ass-backwards
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Earlier this week, the CDC revised its guidelines for covid testing.

For background, the CDC categorized people into “five populations” for which COVID-19 testing may be appropriate:

  1. Individuals with signs or symptoms consistent with COVID-19 (“aka “symptomatics”)
  2. Asymptomatic individuals with recent known or suspected exposure to COVID-19 (e.g. in close contact for more than 15 minutes with an infected person; living in a high COVID-19 transmission area;  having  attended a public or private gathering of more than 10 people (without widespread mask wearing or physical distancing)
  3. Asymptomatic individuals without known or suspected exposure in special settings (e.g. frontline medical personnel and nursing home caregivers)
  4. Individuals being tested to determine resolution of infection (e.g. to establish a safe return to work after a prior positive test)
  5. Individuals being tested for purposes of public health surveillance (e.g. to determine the prevalence of COVID-19 in a targeted locale such as an apparent hot spot city or campus)

The CDC previously recommended testing for people in categories in the first 3 categories.

Here’s the big change to the CDC guidance … and why it’s wacky.

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The Change

In essence, the revised CDC guidance loosens the guidelines for category 2 — the exposed asymptomatics.

Now, the CDC says:

If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:

You do not necessarily need a test unless you are a vulnerable individual or are prescribed to do so by your health care provider or State or local public health officials.

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The Rationale

The CDC doesn’t really provide a rationale, so pundits are going hog wild:

  • Avoiding false sense of security: This is the only explicit acknowledgement that the CDC has made. The argument: testing negative is only operative for a day or so.  Asymptomatics who test negative potentially increase community spread by pocketing their masks and stop practicing social distancing.  Note: This is probably true, but isn’t new news, so shouldn’t be a decision-driver at this time.
  • Speeding test results: The recent quantum level increases in testing have clogged analysis labs and stretched turnaround times to the point that results come too late for therapeutic relevance.
  • Playing politics: The MSM and Dem governors (e.g. Cuomo) assert that the move was orchestrated by the White House simply as a political maneuver aimed at artificially suppressing the count of confirmed cases.  Note: The political impact is equivocal since there will be a certain rise in the positivity rate — the metric that Dr. Birx says is the key number she watches to determine whether the economy and schools should be re-opened.

My hunch: all 3 factors probably motivated the change which obscures a bigger issue….

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Who to test?

Loyal readers know that I’ve questioned the CDC’s testing priorities from the get-go.

My view…

Testing people with COVID-19 symptoms is a waste of resources, especially when results take a couple of days.

For the most part, docs treat patients with flu / COVID symptoms the same way whether they test positive or not: severe symptomatics get hospitalized; mildly symptomatics get sent home and told to self-quarantine.

IMHO, the pay dirt is frequently testing targeted groups of asymptomatics (not those semi-randomly volunteering for tests) to determine the prevalence of COVID in their local communities (i.e. quickly identify hot spots) … and, frequently testing at point-of-entry to keep unknowing infectees from penetrating relatively safe “bubbles”(e.g. daily testing of all students before they enter a classroom or all employees and visitors before they enter a workplace).

The new Abbott $5, 5-minute test is a move in the right direction .. if only they could get it down to less than $1 and less than 1-minute … then we’d have a testing program that is really actionable.

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For more detail, see our prior posts:  If test kits are scarce, let’s test the right people! and Let’s make COVID testing actionable

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Update:

The CDC has already backtracked and “clarified” the guidance gave earlier in the week.

CDC Director Robert Redfield now says, “Everyone who needs a COVID-19 test, can get a test, but everyone who wants a test does not necessarily need a test.”

What Redfield should have added is: While vast numbers of people can be tested, the analysis labs are backlogged, causing delays in results’ reporting … which, in many cases, renders the tests therapeutically worthless.

My routine observation: It’s hard to follow the science if scientists don’t agree … and if the science is unsettled (i.e. constantly changing — both directionally and specifically).

For more details, USA Today has a relatively balanced recap.

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